In the operating room, surgeons are supported by a team of circulating nurses, scrub techs, anesthesia providers, and others who must work together effectively to provide high-quality care. When all members of this health-care team work well together and share a desire to contribute to successful procedures, they can be described as cohesive.

Members of a cohesive team have a mutual respect, open communication, and a unified commitment to the goal, says Apryl McElheny, MBA, MSN, RN, CASC, CIC, senior consultant at Progressive Surgical Solutions, a division of VMG Health, in Gallitzin, Pennsylvania.

A cohesive team culture does not occur naturally, McElheny explains. Creating this culture requires managers to embrace and leverage a team’s strengths and vulnerabilities, along with diversities and similarities, to create trust among team members. By building meaningful relationships, a unified team enjoys workplace harmony, comradery, and synergy, she says.

At an ophthalmic ASC, having a cohesive team is vital to providing the best patient care and achieving the optimal bottom line, says Carrie Jacobs, COE, executive vice president of operations at Chu Surgery Center in Bloomington, Minnesota. Team members support each other. There is a genuine pride in their work and willingness to get the job done.

Without a cohesive team, an entire center may run poorly, which adds to inefficiencies, higher overhead, poor morale, and lower patient satisfaction scores, Jacobs says.

Although the idea of “cohesiveness” may seem subjective, it’s actually quite measurable. Key performance indicators (KPIs) for team cohesiveness may include several quantifiable metrics, such as team velocity (the number of tasks completed within a certain period of time), patient or employee satisfaction scores, the number of milestones or requirements achieved for projects in progress, and cost efficiency with financial and budget figures. “Be transparent with your team regarding KPI definitions, and when and how they will be measured,” McElheny advises.

Strong Leadership

Strong leadership is essential to uniting staff members. It starts at the very top with the owner or managing partners of the surgery center. “When the owners of an ASC show they care, communicate with staff, and are respectful, they in turn will foster a team that will be aligned with their goals,” Jacobs says.

Ideally, a center’s administrator and clinical director will have a solid working relationship. “If they don’t, a team will naturally not be cohesive,” Jacobs says. “Misaligned visions deteriorate and divide teams, so it’s imperative that leadership is strong and united.”

Choosing Team Members

When looking to build a cohesive team, it’s important to choose new hires carefully. Jacobs asks potential candidates to spend half a day shadowing a staff member who works in the position for which the candidate has applied. “We see how they interact with our team and their overall interest level,” she says. “This is the most important step in the interview process. If even one staff member has a negative experience with a shadowing interviewee, we take that feedback very seriously and most likely won’t hire that individual.”

At Key-Whitman Eye Center in Dallas, applicants take personality and mental aptitude tests. “These tools help to analyze how a new potential team member will fit in,” says Nikki Hurley, RN, MBA, COE, director of surgical services. “For instance, if a candidate’s test results indicate that they’re arrogant, overly confident, tend to stretch the truth, or don’t communicate well with others, then they’re not a good fit for us.”

McElheny looks for candidates with qualities such as self-awareness, directness, creativity, amenability, engagement, responsibility, accountability, honesty, ethicality, reliability, resourcefulness, and optimism. She also seeks out critical thinkers with a passion for lifelong learning and professional growth and development.

Todd Albertz, CASC, director of healthcare solutions at Eckert Wordell—an architecture, interior design, MEP engineering, and consulting services firm in Kalamazoo, Michigan—is a huge supporter of promoting from within. In fact, over the years many of the firm’s leaders were formerly staff members. He is keenly aware of how valuable developing and advancing staff within an ASC can be to staff retention and morale. “It’s important to have a clear path for nurses to move into advanced roles such as infection control, charge nurse, assistant director of nursing, and nursing director,” Albertz says.

Building Cohesiveness

There are many strategies to build and improve team cohesiveness, beginning with training and development. Albertz believes in a robust training program for new employees, including assigning them to a preceptor through the onboarding process. The leadership team should routinely check with new team members throughout this process to make sure they’re progressing and are comfortable with their duties.

When a new member joins her team, McElheny provides organizational documents such as the operational chart and team charter, which contain the lines of authority and reporting structures. This way, when issues arise, the team member can quickly determine where to go for help or who to consult on the problem.

Education and training are offered in multiple formats. Information is provided on milestones that employees are expected to achieve and competencies they should attain. McElheny pairs new hires with mentors, and routinely evaluates them and provides feedback. New team members should also have the opportunity to provide feedback regarding their onboarding experiences, she says.

Chu Surgery Center holds weekly team meetings and monthly educational sessions in addition to skills training as needed. “Team members feel more confident and aligned when they can authoritatively speak about our procedures and technologies,” Jacobs says.

Defining roles and responsibilities is another way to build cohesiveness. “This enables team members to develop an understanding of what needs to be accomplished and what they’re expected to contribute,” McElheny says. “Clarifying roles encourages accountability, autonomy, efficiency, and collaboration among team members.”

Creating a culture that embraces communication is also critical. Communication starts with the leadership team and flows through to all team members, Albertz says. One idea to improve communication in a surgery center involves holding morning “huddles” to discuss hot-button issues and provide an overview of the day. Regular meetings are an important way to notify staff of any updates, such as new procedures or technologies being introduced, changes to policies or procedures, and new employee hires.

Staff at Chu Surgery Center huddle before every surgery day to align the entire team on the patient list, any special needs, and other matters. After the last case is completed, they meet again to discuss how the day went, address any issues that occurred, review equipment and supply needs, and share ideas for the future.

Setting goals is also a key to forming cohesiveness. All goals established for a team should be SMART—Specific, Measurable, Attainable, Realistic, and Time-bound—and should align with an ASC’s short-term and long-term goals, McElheny says. Developing an action plan to meet these goals should be a team effort. Each goal should have a timeline with milestones to track progress.

Working toward a goal allows team members to celebrate victories along the way and enables them to deal with obstacles together. McElheny suggests recognizing team members for their hard work and says managers should consider tying incentives to performance. Establishing goals will empower team members, which can improve job satisfaction, drive accountability, and foster a collaborative work culture. Goals should not be set in stone, however, and must be routinely evaluated, McElheny says.

Team Building Activities

Events and activities can also help team members form stronger relationships. McElheny recommends trivia games, scavenger hunts, introductory exercise classes for yoga or Zumba, kickball games, or a day at an amusement park. There are many known advantages to scheduling time for team-building activities, including improving morale, building relationships, preventing and reducing conflict, encouraging communication, and driving innovation. These activities can also curb boredom and workplace monotony, as team members learn more about their colleagues’ hidden talents.

At Key-Whitman Eye Center, a committee of team members helps to plan events. Every quarter, a fun activity outside the office is planned, such as miniature golf or an outing to a family fun center. They choose a day when one of the surgeons is out, so the office can close early and there’s lots of time for the activity. They also have monthly potluck lunches, celebrate birthdays with cake, and keep favorite snacks on hand for staff.

Philanthropic team-building exercises are also an excellent way to build comradery, McElheny says. Some ways that a team can serve their community is by spearheading a food drive, planting a garden for food dessert communities, or organizing a charity fundraiser.

ASCs looking for low-cost fun activities may want to consider pot luck gatherings, cook-outs, cornhole tournaments, and holiday parties, Albertz says.

Balancing Staffing Levels

Having the right number of team members also plays a role in team cohesiveness. Establishing ideal staffing levels at an ASC can be challenging, however, because volume and patient acuity changes daily. Keeping overhead in check, remaining within budget, meeting productivity goals, and retaining staff, all while providing safe and effective patient care, can be a balancing act, McElheny says.

Research suggests that lean teams are more efficient, use allocated resources more responsibly, and have better working relationships due to the transparency of roles, McElheny says.

Hurley’s ASC has a lean team, which she says encourages cross-training. This helps each individual appreciate the tasks of another person’s job role and leads to better cohesion. Lean teams tend to have less drama and headaches because everyone is very busy and working hard. “I believe there is a better sense of pride with leaner teams because we accomplished our goals together and had to work hard to get there,” she says.

Lean teams are often a mechanism for cost containment, but not without risk, however, McElheny says. When teams are lean there is a low margin for mistakes or poor staffing decisions.

Overstaffing, on the other hand, can have detrimental impacts on a center’s bottom line and can result in staff disengagement, attendance issues, loss of productivity due to inefficiencies, and slipping morale, McElheny says. However, there are advantages to overstaffing, such as preventing burnout and not having to fill a vacant position immediately because existing employees can compensate for the loss.

Benefits Abound

There are many advantages to having a cohesive team in the ASC. Collaborative teamwork results in fewer errors and improved patient safety and outcomes. A team that works cohesively requires less managerial oversight because each member self-monitors and holds themselves accountable for their work, especially when the team’s efforts are rewarded with greater autonomy. Expect financial gains as well, McElheny concludes. ■